Why are physicians not ordering annual Stool Tests?

[drrich2]

What - you don’t have to use GoLytely (aka Poop Muchly) anymore?

Thankfully no, and this is worth highlighting. Many years ago, one of my parents was to get a colonoscopy, and had what looked to me like a roughly 1-gallon jug of 'GoLytely' - it was my understanding having to drink that was something of a miserable ordeal. After I turned 50, it was my turn and I dreaded it (but with a background in health care, I've encountered colon cancer patients and do not want to be one). I'd also in health care training witnessed colonoscopies, and picturing the physician taking that scope for a scenic 'road tour' of my colon while I felt badly constipated or some such sounded quite unpleasant and embarrassing.

Here's what I recall from the actual experience:

1.) No GoLytely.

2.) Go to Wal-mart, buy some Dulcolax and MgCitrate (flavored; I got cherry). The latter was initially okay but the taste got unpleasant with time, but not terrible, and not nearly the volume I feared with GoLytely. At some point got a home enema (wife's a nurse by training; comes in handy).

3.) I could have clear liquids and some other things that day, including these banana flavored popsicles I liked.

4.) Yes, I hit the bathroom off and on, but I wasn't parked on the throne for hours, making mad dashes to get to it, etc... I don't recall major abdominal cramping.

5.) The next morning at the hospital, at least 2 people explained that propofol was involved in Michael Jackson's fatality but I'd get much lower doses and was not expected to die. They gave me the anesthesia, I decided to count to 10 but only made it to 8, and...

6.) Next thing I knew my wife was shaking me awake in the recovery room after the procedure. After effects were apparently mild; I don't recall any major problems.

My case is one anecdote, your mileage may vary. It wasn't my idea of a fun day (I love to eat), but it wasn't some ordeal to dread, either.

 

[Marie13]

Thankfully no, and this is worth highlighting. Many years ago, one of my parents was to get a colonoscopy, and had what looked to me like a roughly 1-gallon jug of 'GoLytely' - it was my understanding having to drink that was something of a miserable ordeal. After I turned 50, it was my turn and I dreaded it (but with a background in health care, I've encountered colon cancer patients and do not want to be one). I'd also in health care training witnessed colonoscopies, and picturing the physician taking that scope for a scenic 'road tour' of my colon while I felt badly constipated or some such sounded quite unpleasant and embarrassing.

Here's what I recall from the actual experience:

1.) No GoLytely.

2.) Go to Wal-mart, buy some Dulcolax and MgCitrate (flavored; I got cherry). The latter was initially okay but the taste got unpleasant with time, but not terrible, and not nearly the volume I feared with GoLytely. At some point got a home enema (wife's a nurse by training; comes in handy).

3.) I could have clear liquids and some other things that day, including these banana flavored popsicles I liked.

4.) Yes, I hit the bathroom off and on, but I wasn't parked on the throne for hours, making mad dashes to get to it, etc... I don't recall major abdominal cramping.

5.) The next morning at the hospital, at least 2 people explained that propofol was involved in Michael Jackson's fatality but I'd get much lower doses and was not expected to die. They gave me the anesthesia, I decided to count to 10 but only made it to 8, and...

6.) Next thing I knew my wife was shaking me awake in the recovery room after the procedure. After effects were apparently mild; I don't recall any major problems.

My case is one anecdote, your mileage may vary. It wasn't my idea of a fun day (I love to eat), but it wasn't some ordeal to dread, either.

GoLytely is some nasty ****. It was a 1 gallon jug. I couldn’t keep it down after a certain point and the doc had to give me something to stop the nausea. I mixed it with Sprite.

 

[Reef Madness]

They should give you a sticker afterward, kinda like they do for voting in the US. Sure to be a conversation starter at the grocery (especially if you wear your “divers do it deeper” tee). Really though, I agree it’s worth the prep discomfort to do it right.

 

[Lorenzoid]

I, too, recall having to drink like a gallon of some sort of solution before my last colonoscopy four years ago. Looks like what my wife's doctor ordered taken before her upcoming colonoscopy is called Clenpiq: a box of two 160ml bottles, each containing 10mg sodium picosulfate and 3.5g magnesium oxide. It says to follow with plenty of clear liquids, but no need to dilute.

 

[DandyDon]

The next morning at the hospital, at least 2 people explained that propofol was involved in Michael Jackson's fatality but I'd get much lower doses and was not expected to die.

Does that facility ever experience patients bolting?

After effects were apparently mild; I don't recall any major problems.

Nope. I think I felt borderline drunk and slept more that afternoon. I slept well thru the procedure, but got bored waiting for the doctor to release me after I awoke.

I had a chest angiogram in January and a leg angiogram in February. I slept thru those, woke up feeling fine altho still under the influence, ready for lunch. I'm sitting around today waiting on a call to tell me when to be at the facility for my other leg Wednesday.

 

[Ukmc]

Interesting PDF. I'm not up to actually reading a 13 page study. but thanks. They seem stuck on screening starting at age 45 even tho people in their 20s and 30s are getting cancer. As easy as a Stool Test is, why wait.

That's great for the few who will do a colonoscopy, but so few will.

Which test?

That's a big risk for someone with that history. It's a big risk for anyone. Not that I haven't gone years without insurance at times, as I have, but I survived to know better now. Insurance is in case of need, not a program you expect to use.

There's the worst-case problem with the tests. I am suspicious of one that advertises on FB. Best wishes to her and you here support partner.

Well, I believe you asked why physicians order or not order a test. Well they go to a school for a long time, then they use this knowledge and experience to practice evidence based medicine (most of the time). To take a step further - US preventive services task force employs physicians and statisticians to summarize the evidence and puts it into guidelines (14 page document) so every physician does not have to re-invent the wheel. There is an one page table in the document that summarizes some of the whys and why-nots if the rest of the document is a hard read.

 

[tridacna]

Well, I believe you asked why physicians order or not order a test. Well they go to a school for a long time, then they use this knowledge and experience to practice evidence based medicine (most of the time). To take a step further - US preventive services task force employs physicians and statisticians to summarize the evidence and puts it into guidelines (14 page document) so every physician does not have to re-invent the wheel. There is an one page table in the document that summarizes some of the whys and why-nots if the rest of the document is a hard read.

At last. An answer from a doctor. (Ahem. Excluding our resident psychiatrist of course).

 

[Miyaru]

So, why are physicians not ordering annual Stool Tests for all?

For all?
A little bit more faith in nature would benefit the unbalanced overpopulation of humans on this planet.
That may sound harsh and lacks compassion, blame nature for that.

 

[Akimbo]

For all?

What is the convention in Europe for colon cancer screening? Is it consistent across the EU?

 

[RyanT]

@Akimbo: it's my understanding that the majority of colon cancers develop within pre-cancerous polyps. The polyps grow slowly and most won't develop into cancer. But removing them with a colonoscopy is relatively easy. If you scroll down a bit, you can see the progression illustrated in the figure in this link.

They found colon polyps: Now what? - Harvard Health

If you have some papers showing that the cancer develops first and then the polyp develops around it, I'd love to get the reference from you. You do bring up a good point about the age issue. 50 used to be the recommended first colonoscopy, now it's 45, and for good reason. A colonoscopy found precancerous polyps (severe dysplasia in the diagram in the link) in a family member at age 48. I was very happy she did not wait until 50.